Individual
PETER CHARLES GROSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1005 COMMERCIAL LANE, GODWIN BLDG ON RT 10, SUITE 220, SUFFOLK, VA 23434-8149
(757) 668-2600
(757) 668-2620
Mailing address
1005 COMMERCIAL LANE, GODWIN BLDG ON RT 10, SUITE 220, SUFFOLK, VA 23434-8149
(757) 668-2600
(757) 668-2620
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101042222
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6746209
—
VA
05
—
890583W
—
NC
Enumeration date
04/22/2006
Last updated
12/10/2012
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